Advancement Flap Research Articles

Oroantral Fistula Reconstruction by Pedicled Buccal Pad of Fat adjuvant with Advancement Flap (Clinical Study)

Aim: As well as highlighting the role of buccal fat of pad in closure large defects by evaluating healing process through pain, swelling and wound healing scores. Material and Method: A prospective evaluation study was conducted among patients who underwent surgical closure to OAC in both Ear Nose and Throat Department with the Maxillofacial Department of Al-Salam Teaching Hospital in Mosul City of Nineveh Province. Data recorded includes demographical Information and clinical evaluations. Two operators measured the parameters. Pain and swelling assessment through the visual analogue scale (VAS) assess the level of pain on the third, seventh and day twenty following surgery. Wound Evaluation Scale used to evaluate closure of the oroantral communication without nasal regurgitation at 1st week (day 7) and 20th days post- surgery and measure the surgical success. Results: The highest age group are between (20-29 years) with percent (56.5). male show high incidence (56.5%) more than female (43.47). In regard to cause extraction followed by tumors are the common cause for oroantral fistula (56.5%, 17.39). Day three and seven reflect different ranges of pain with highest percent for severe pain in day three (65.21%) and reduced to slight pain (82.60%) in day seven. In regard to swelling, in day three most of cases show very severe swelling (73.91%). In day seven the cases represent sever swelling (78.26%). Twenty-one patients from total 23 show incomplete healing at day seven while two patients have uncertain healing. In day 20 just one patient shows incomplete healing process. Conclusion: Buccal pad of fat can be used safely as adjuvant to buccal advancement flap for closure and is efficient in management of OAC to avoid diminished soft tissue in different size cases. Pain, swelling scales can be used as assessment for healing process added to them soft tissue wound healing scale.

Staged Regenerative-Phenotype Modification Therapy for Multiple RT3 Gingival Recessions in Periodontally Compromised Anterior Mandibular Teeth: A Case Report.

We report the successful treatment of multiple recession type (RT) 3 gingival recessions in periodontally compromised mandibular anterior teeth with limited keratinized tissue. A 35-yearold man with stage III, grade C periodontitis underwent a two-stage intervention. Initially, a modification of the connective tissue graft (m-CTG) wall technique was used as part of phenotype modification therapy. The CTG acted as a protective 'wall,' securing space for periodontal regeneration, enhancing root coverage, soft tissue thickness, and keratinized mucosal width. Recombinant human fibroblast growth factor-2 and carbonate apatite promoted periodontal regeneration. This procedure successfully facilitated periodontal regeneration, resulting in the transition from RT3 to RT2 gingival recession and adequate keratinized mucosal width. Eighteen months later, the second surgery used a tunneled coronally advanced flap (TCAF) for root coverage. TCAF involved combining a coronally advanced flap and tunnel technique by elevating the trapezoidal surgical papilla and using a de-epithelialized CTG inserted beneath the tunneled flap. Root conditioning with ethylenediaminetetraacetic acid and enamel matrix derivative gel application were performed. Consequently, mean CAL gain was 5.3 mm, mean root coverage was 4.5 mm in height, and the gingival phenotype improved at the treated sites by the 12-month follow-up. This staged approach addresses the challenges of treating RT3 gingival recession with promising outcomes.

Utility of large V-Y advancement of the latissimus dorsi myocutaneous flap in the reconstruction of large thoracic defects: a case series and literature review

BackgroundTrunk reconstruction following sarcoma excision involves significant defects. Pedicled and free latissimus dorsi myocutaneous flap (LDMF) reconstruction is commonly employed for thoracic defects; however, skin paddle design is limited to 10-12 cm to achieve primary donor closure. Paucity of data exists regarding the utility of V-Y advancement of LDMF, previously described for moderately sized thoracic defects. Efficacy of the technique's application, axial reach, maximum skin paddle, and overall success or complications have not been defined in the literature. MethodsA retrospective review of records was conducted from 2015 to 2021 at our center to identify patients who underwent large, islanded V-Y LDMF reconstructions. Results were assessed by reviewing photographs and clinical notes. PubMed search of articles using the search terms “Latissimus Dorsi Flap Reconstruction” AND “V-Y” was conducted, abstracts were screened, and relevant articles were selected for review by the 2 author (NL/YS). We summarized the findings in our review and discussion. ResultsEleven patients underwent V-Y LDMF reconstruction with large skin paddles designed to close the donor site and oncological defect. Flaps were mobilized in superior (n = 7), anterior (n = 2), inferior (n = 1) and medial (n = 1) directions. Satisfactory coverage and patient recovery with few complications was achieved. Average length of hospital stay was 4.7 days and secondary surgery was not required. Discussion and conclusionV-Y advancement of LDMF is reliable up to 24 cm axially with a skin paddle width of 24 cm based superiorly, inferiorly, or anteriorly. The technique is safe and effective in comorbid patients following high-dose radiotherapy, without prolonged general anesthesia or microsurgery. It represents a versatile locoregional reconstructive option for large trunk defects.

Predictive Factors for Recurrence of Fistula-in-Ano After Surgery: A 10-year Experience in a Single Center Study

OBJECTIVE This study aimed to evaluate the recurrence rate of fistula- in-ano treatment and factors associated with recurrence. METHODS A retrospective cohort study was performed of cryptoglandular-cause fistula-in-ano patients who underwent surgery between January 2010 and June 2020. Cox’s regression analysis was used to identify predictive factors for recurrence FIA. RESULTS The study included 282 patients of whom 233 (82.6%) were male, 76 (27.0%) had previous anal fistula surgery, 77 (27.3%) had a complex type of fistula, 72 (25.5%) were high transphincteric, 3 (1.0%) were suprasphincteric, and 2 (0.7%) were extrasphincteric. Five types of operations were performed: 106 (37.6%) fistulotomies, 43 (15.2%) fistulectomies, five (1.8%) setons, six (2.1%) endorectal advancement flaps (ERAF), and 122 (43.3%) ligations of the intersphincteric fistula tract (LIFT). The recurrence rate was 20.1% (57 patients) among whom 54 (94.0%) were detected at follow- up within 12 months, 2 patients were detected in the second year, and 1 patient was detected in the third year. Four independent factors associated with the recurrence of FIA after surgery were identified: female gender (HR 2.67; 95% CI 1.34-5.34), BMI >25 kg/m2 (HR 2.47; 95% CI 1.38-4.44), complex type of fistula (HR 2.02; 95% CI 1.02-3.97), and anterior opening (HR 2.14; 95% CI 1.12-4.10). Compared to the LIFT procedure, fistulotomy was the protective factor (HR 0.12; 95% CI 0.03-0.46) while ERAF had a higher rate of recurrence (HR 6.12; 95% CI 1.87-20.03). CONCLUSIONS Patients with high BMI and female patients should be advised of the higher chance of recurrence after anal fistula surgery. More complex fistula-in-ano and sphincter-preserving surgery was also associated with a higher recurrence rate. The complete healing of the surgery should be monitored for two years after surgery. KEYWORDS predictive factors, recurrence, fistula-in-ano, anal fistula

Modified reverse Hughes technique for upper eyelid reconstruction – Case report

Patients with scarring in the eyelids present a significant surgical challenge, particularly when the scarring results from severe trauma. This case report describes a young female patient with a history of keloid formation who sustained an upper eyelid trauma, resulting in extensive tissue avulsion and damage to the upper canaliculus. An upper eyelid reconstruction was undertaken using the tarsoconjunctival flap advancement procedure (modified reverse Hughes) for both the lower and upper eyelids to reconstruct the defect. This reconstruction facilitated anatomic and functional recovery, including eyelid opening and closing, and appearance.

Step ladder VY advancement flap for lower eyelid reconstruction after resection eyelid malignant tumors

BackgroundIn oculoplastic surgery, reconstruction of a large defect after the removal of a massive malignant lower lid tumor still represents a unique challenge. We will report on this case, including a presentation of the case using step ladder V–Y advancement flap.MethodsDuring November 2018 to March 2023, five patients of lower eyelid malignant tumor had wide resection with safety margin and reconstructed using step ladder V–Y advancement flap. The flap was used step ladder V–Y advancement flap.ResultsNo complications, including ectropion deformity, occurred. This flap does not sacrifice healthy skin as seen with the cheek rotation flap, and the area of dissection is very small and can be performed in a short time.ConclusionsStep ladder V–Y advancement flap is highly useful in cases that require a reconstruction of a large defect after the removal of a massive malignant lower lid tumor from viewpoints of operating time, ease of procedure, aesthetics, and complications.

Double opposing five flaps as an easy way to correct post burn band contracture

Post burn contracture usually need interference mostly for functional or cosmetic correction. Release and skin graft is the first option in the reconstructive ladder; it has its drawbacks either re-contracture or pigmentation of the graft. Release and flap coverage when available is the best. Free flaps, at a time, was the best and last option in the reconstructive ladder. Still, it is the most expensive surgery that consumes a long time for flap raising, anastomosis of its vessels, in addition to donner site morbidity, the need for stages of defatening and the possibility of failure.Local flaps if available is the easiest technique for all plastic surgeons even the beginners. Back to basic: advancement, transposition and rotation flap are easy for any plastic surgeon. Linear scaring or contracture usually can be corrected by Z plasty or multiple Z if long. Sometimes double opposing Z plasties (5 flaps release) is used if one side of the line is healthy and the other is scared.Z plasty and its varieties are not enough to correct very broad band contracture since its release usually develops large defect. In that case even the free flap alone is not enough; split skin graft is mandatory to complete the defect coverage.Our technique is only for band contracture that neither very broad nor linear, and is surrounded by healthy skin, that technique is double opposing 5 flap (DO5F) release.

How We Do It: Medial Canthal Repair via Double V to Y Advancement Flap.

How We Do It: Medial Canthal Repair via Double V to Y Advancement Flap.

(070) SUCCESSFUL TREATMENT OF NEUROPROLIFERATIVE VESTIBULODYNIA IN MENOPAUSAL PATIENTS

Abstract Introduction As pain symptoms from neuroproliferative vestibulodynia (NPV) often arise at initial attempt at tampon insertion or penetrative sex, most vestibulodynia patients present in their 20’s or 30’s. Consequently, individuals who reached this age prior to 2004-when Dr. Bornstein and colleagues delineated the excess mast cell and nerve pathology-had limited opportunity for successful NPV diagnosis and treatment. Menopausal patients often experience vulvar pain with genitourinary syndrome of menopause (GSM) due to the paucity of sex steroid hormonal support of their genital tissues. While symptoms of painful penetration are similar in both of these conditions, NPV is diagnosed when severe allodynia/hyperalgesia is still present with a normal or corrected hormonal milieu. A treatment for NPV is complete vestibulectomy surgery, performed in premenopausal eugonadal patients. However, in hormonally depleted patients with GSM, the vaginal tissue is thinner and less robust making it less optimal for reconstructive surgery. Objective To examine the intersection of genitourinary syndrome of menopause and neuroproliferative vestibulodynia symptoms in a subgroup of at-risk patients and to report techniques for optimizing management of this patient population. Methods We reviewed charts of two menopausal patients with NPV and report a clinical strategy for successful management. Results Two patients, ages 58 and 63 reported histories consistent with NPV during their reproductive years-one with lifelong entrance pain with any insertion and one with pain-free penetration prior to experiencing severe burning upon use of topical miconazole for candidiasis. At presentation, both had entry pain symptoms consistent with GSM and NPV. Since NPV is a diagnosis of exclusion, each was treated for GSM with intravaginal DHEA and vestibular topical compounded testosterone/estradiol cream. After 6 months, vestibular pallor and erythema resolved, however, cotton-tip swab testing scores did not improve. A positive improvement with vestibular anesthesia testing was consistent with NPV. Each underwent a complete vestibulectomy with vaginal advancement flap with successful wound healing and no adverse events despite their age and prior GSM diagnosis. Both patients report “very much better” symptoms on post-op Patient Global Impression of Improvement. Immunohistochemical staining of excised vestibular tissue confirmed a high density of CD117 and PGP9.5 staining consistent with an NPV diagnosis. Each patient has continued their menopause treatments post-op. Conclusions We report on two menopausal patients with NPV who had classic symptoms of severe allodynia/hyperalgesia in their reproductive years but who were not managed as NPV patients due to lack of knowledge at that time. Treating the GSM first with hormone replacement may restore health to vaginal tissues, thereby allowing the excised vestibular region to be covered with a vaginal advancement flap. Managing GSM symptoms prior and then undergoing vestibulectomy allowed them to have pain-free penetration. Disclosure No.

(027) HIGH PREVALENCE OF SYMPTOMATIC CLITORAL ADHESIONS IN PATIENTS WITH NEUROPROLIFERATIVE VESTIBULODYNIA UNDERGOING VESTIBULECTOMY

Abstract Introduction Clitoral adhesions occur when the epithelial skin surfaces of the prepuce and glans clitoris become adherent. The severity of clitoral adhesions is best documented during full prepucial retraction using vulvoscopy with photography; mild, moderate, and severe clitoral adhesions occur when there is >75%, 25-75%, and <25% visualization of the glans clitoris, respectively. Clitoral adhesions are associated with a closed compartment with inadequate clearance of keratinaceous sloughed material from the epithelial surfaces of the prepuce and glans clitoris. This trapped material may form keratin pearls resulting in local inflammation and glans hypersensitivity/pain. In one study of 614 evaluable individuals with vulvas who presented to a sexual medicine clinic for various sexual dysfunctions, 23% demonstrated clitoral adhesions based on vulvoscopy with photography (mild 44%, moderate 34%, and severe 22%) of which 14% complained of clitoral hypersensitivity/pain. We observe symptomatic and asymptomatic clitoral adhesions occurring in women presenting with entry dyspareunia, severe allodynia and hyperalgesia, who are clinical suspected and pathologically conformed to have neuroproliferative vestibulodynia (NPV). Surgical management of the NPV involves complete vestibulectomy with vaginal advancement flap. For those patients who also have clitoral adhesions, lysis of clitoral adhesions may be performed at the time of vestibulectomy. Objective To examine the association between clitoral adhesions and NPV. Methods A retrospective chart review of patients with NPV who underwent vestibulectomy and lysis of clitoral adhesions concomitantly between January 1, 2021 and October 31, 2023 was performed. History, physical examination, pre-op vulvoscopy with photographs, operative records and patient outcome data were collected. Results Sixty-three patients with NPV, (mean age 29, range 19 – 64 years), underwent vestibulectomy surgery. A total of 34 (54%) of these patients underwent concomitant lysis of (mild (38%), moderate (50%), or severe (12%) clitoral adhesions. Multiple keratin pearls were removed in 91% of cases. More than half (53%) of these patients with NPV and clitoral adhesions complained of glans hypersensitivity/pain during pre-op vulvoscopy. The majority (88%) of this cohort reported “somewhat better” or “very much better” on PGI-I after lysis of adhesions. No negative side effects following the lysis of clitoral adhesions were noted. Conclusions There is a high prevalence of symptomatic clitoral adhesions in patients with NPV (53%) compared to women who presented to a sexual medicine clinic for other sexual concerns (14%). While clitoral adhesions are not always symptomatic, we hypothesize the high prevalence in patients with NPV may be due any of the following: i) pain/stress resulting in peripheral nerves releasing neurotransmitters that stimulate proliferation/differentiation of prepucial sebaceous glands and upregulate prepucial sebaceous cell lipid synthesis, ii) infrequency of clitoral tissue engorgement from sexual activity, iii) limitation or aversion to touching or retracting clitoral prepucial tissue, iv) increased frequency of wearing menstrual pads rather than tampons, v) severe genital pain perceived as co-existing in both vestibule and clitoris and vi) the patient is already scheduled for surgery under anesthesia so the patient conveniently agrees to also undergo lysis of adhesions. Clinicians should be aware of this high association. Disclosure No.

(042) IMMUNOSTAINING FOR MARKERS OF MAST CELLS AND NERVES IN BOTH EXCISED VESTIBULAR AND ENDOMETRIOSIS IMPLANT TISSUES IN A SINGLE PATIENT

Abstract Introduction Neuroproliferative vestibulodynia (NPV) is a chronic genital pain condition characterized by severe vestibular allodynia and hyperalgesia. The clinically suspected diagnosis of NPV is confirmed in excised vestibular tissue by immunohistochemical staining of > 8 cells per 100x magnification positively immunostained for CD 117, a mast cell marker, and 10 times the area compared to controls positively immunostained for PGP 9.5, a neuronal marker, Endometriosis, on the other hand, is a chronic pelvic pain condition associated with growth of ectopic endometrial-like tissue outside the uterus. The clinically suspected diagnosis is confirmed in excised endometriosis tissue revealing, in some patients, endometrial type glands and/or stroma. In patients with NPV and endometriosis, it is hypothesized that excess mast cells release cytokines and growth factors that promote neuroproliferation in their respective tissues, resulting in chronic genital and pelvic pain symptoms, respectively. In a study involving 65 patients with pathologically confirmed NPV, 63% reported having additional conditions associated with aberrant mast cell activity, including endometriosis. The conditions of NPV and endometriosis may both be focal to the vestibule and pelvis, respectively, but both may also share pathologies of aberrant mast cell activity with other systemic disorders. Objective To perform immunostaining for markers of mast cells and nerves in excised vestibular and endometriosis implant tissues from a single patient. Methods Fixed, paraffin-embedded vestibular tissue specimens from the 1:00-11:00 and 12:00 vestibule, and from excised endometriosis fibroadipose tissue on the rectosigmoid colon, were sectioned and immunostained for CD 117 (C-kit) and PGP 9.5. The immunostained slides were examined and digital photomicrographs taken. A minimum of 2 photomicrographs were examined at 100x magnification for each stained slide, identifying representative regions of the excised tissue. Manual counting of CD117 and PGP 9.5 immunopositive profiles, cells/nerves per 100x magnification, was performed for each photomicrograph. Results A 23-year-old woman presented with a history marked by painful and prolonged menstrual periods, inability to insert tampons, and discomfort with both entry and deep thrusting during intercourse. After excluding other forms of vestibulodynia, she underwent complete 1:00-11:00 and 12:00 subepithelial vestibulectomy with vaginal advancement flap reconstruction. Post-operatively, she reported “very much better” symptoms, with a reduction of entrance dyspareunia, but continued to experience deep thrusting pain with penetrative sexual activity. She subsequently underwent endometriosis excision surgery with positive lesions identified in 12 locations in the pelvis and retroperitoneum. Tissue stained for CD117 and PGP9.5 analyzed by manual counting exhibited > 20 immunopositive cells and nerves per 100x microscopic field in the epithelial basement membrane and adjacent subepithelial regions of the 1:00-11:00 and 12:00 vestibule, as well as in the endometriosis fibroadipose tissue on the rectosigmoid colon. Conclusions We report for the first time, in a single patient diagnosed with both NPV and endometriosis, immunostaining findings of high densities of mast cells and nerves in their respective tissues. These findings reinforce the hypothesis that NPV and endometriosis are linked to a broader condition associated with aberrant mast cell activity. Disclosure No.

Surgical reconstruction of the temporal-zygomatic area using a mandibular Burow's triangle advancement flap.

Surgical reconstruction of the temporal-zygomatic area using a mandibular Burow's triangle advancement flap.

Multi-Subunit Repair With the Nasolabial Burow's Advancement Flap.

We will describe the use of nasolabial Burow's advancement flaps (perialar crescentic advancements) to repair multi subunit defects of the nasal sidewall including the adjacent cheek, dorsum, tip, and ala without the need of additional flaps. This retrospective single centre study analyzed 6 month postoperative photographs using the Manchester Scar scale. The operative technique is described in detail. Of 355 cases, 336 were available for analysis. The median Manchester Scar scale was 7 for both sidewall defects and multi-subunit defects. There were low rates of infection or necrosis. With the correct technique, the nasolabial Burow's advancement alone is suitable to repair even large multi-subunit defects involving the nasal sidewall, cheek, dorsum, tip, and ala with high-level aesthetic and functional results.

The mucosal released‐coronally advanced flap: A novel surgical approach—A case report

AbstractBackgroundThe coronally advanced flap (CAF) can be a predictable surgical technique for the treatment of gingival recessions. However, the characteristics of the defect (e.g., limited amount of keratinized gingiva or flap tension, etc.) may limit the use of the CAF with a possible requirement of additional surgical interventions (i.e., the use of a tissue graft to be harvested from donor sites or connective tissue substitutes).MethodsA 28‐year‐old woman patient, with no history of periodontal disease, came for referral presenting receding gums as a chief complaint, poor esthetics, and dentinal hypersensitivity at the buccal surface of teeth 11, 12, and 13. Clinically, she presented a thick phenotype with gingival recession type, RT1, with detectable cemento‐enamel junction (A‒) in the second quadrant. To reduce the need of harvesting soft tissue grafts, the amount of cutting of muscles and vessels from the inner portion of the flap and mitigate the postoperative discomfort associated with the CAF, a novel surgical approach is described here using an advanced flap that incorporates an external incision along the mucogingival junction.ResultsThe average root coverage achieved with the novel procedure presented in this case report was 95%, along with an increased amount of keratinized gingiva and minimal postoperative patient's discomfort.ConclusionsThe mucosal released CAF is a promising technique in which the CAF technique alone may not be an indication.Key pointsThis technique has the following advantages: Reduce the need of harvesting soft tissue grafts. Reduce the amount of cutting of muscles and vessels from the inner portion of the flap. Minimal postoperative discomfort for the patient.

Selecting Flap Transfer Methods to Repair Helix Soft Tissue Defect Based on the Direction of Long Axis.

The posterior auricular flap has long been favored for repairing skin defects on the ear's surface. However, achieving optimal esthetic outcomes in ear reconstruction requires a flexible approach to flap transfer methods. While bipedicle advancement flaps are commonly used for body wound coverage, they are rarely used in auricular defect repair. To propose a modified flap transfer approach based on the orientation of the auricular defect's long axis and assess the postoperative esthetic outcomes. The authors reported 12 patients treated using 2 distinct flap transfer techniques. Mild to moderate helix soft tissue defects remained after excision of the masses. A direct island flap was created for patients with longitudinal defects to cover the defect. For patients with transverse defects, a combination of bipedicle and island flaps was used for repair. Scar quality and esthetic outcomes were assessed at least 6 months postsurgery using the Scar Cosmesis Assessment and Rating scale. All patients experienced no serious complications and achieved excellent cosmetic results. Patients undergoing combined flap transfer exhibited relatively more favorable esthetic outcomes. The authors propose a novel concept for repairing helix soft tissue defects by designing local flaps based on the direction of the defect's long axis. For repairing helix soft tissue defects with a long axis parallel to the auricular edge, the combined utilization of bipedicle advancement flap and island rotation flap transfer should be consideration more.

“Flap-in-Flap” Technique: Double V-Y Flap in Fingertip Injury Management

Abstract Background Fingertip injuries with amputation are one of the common hand injury problems. Several reconstructive options are available for fingertip injury. V-Y advancement flap is one of the common flaps. In some cases, their advancement capacities are not sufficient to cover the whole defect, resulting in flexion deformity of the distal interphalangeal (DIP) joint, loss of finger pulp shape, or hooked deformity. The double V-Y flap consists of harvesting two cutaneous flaps on the same neurovascular digital palmar bundle. The first V-Y flap is raised as a neurovascular flap and the second flap is an advancement V-Y plasty. Objectives This article evaluates the outcomes of the double V-Y advancement flap for the fingertip reconstruction. Materials and Methods This is a prospective study on 19 patients with zone II and III fingertip amputation tip defects between December 2021 and June 2023. The majority were workplace injuries. Results There were 16 males and 3 females. The average static two-point discrimination was 6 mm. Average advancement of first flap is 8.5 mm and the average advancement of second flap is 4.3 mm. The average total advancement of a double V-Y flap is 12.94 mm (10–15 mm). All of them had “good” total active motion with movement > 210. One patient had flexion deformity at the DIP joint without causing any functional disturbance. All the flaps settled well except for one patient who had superficial partial necrosis of flap which was managed conservatively. Conclusion This is simple and safe for the reconstruction of zone II and III fingertip amputations with the advantage of like-for-like tissue with near-normal sensation. The second flap increased the advancement of the proximal flap, restoring the pulp shape, and thereby reconstructing a functional and aesthetic fingertip.

Reverse circumcision foreskin advancement flap for reconstructing penile shaft skin defects in adults with burn injuries in the perineal region

AimGenital burns are rare injuries. Reconstruction of penile skin defects should consider cosmetic and functional outcomes. Skin grafts can develop scar contractures and carry hair follicles, causing unwanted results. These downsides remain unsolved issues. This work aimed to describe a new foreskin advancement flap method for completely reconstructing penile shaft skin defects in severely burned patients. Materials and methodsFrom 2021 to 2023, four patients with third-degree burns in the genital area were enrolled in this investigation. We describe a series of cases with deep burns to the penile shaft and surrounding area that needed debridement and reconstruction using a novel technique called “reverse circumcision,” which consists of tangential excision of the penis and a foreskin advancement flap without longitudinal cuts with less morbidity, preservation of function, and a better aesthetic appearance. The patients had an average follow-up of nine months. ResultsThe reverse circumcision technique was established for patients with severe burns in the genital area. The four patients were satisfied with the postoperative results and the aesthetic results of the procedure without reporting any complications. No scarring or contractures were observed on the glans or penile shaft after surgery. ConclusionsCompared with other flap methods, the use of a reverse circumcision foreskin advancement flap was more straightforward, feasible, and effective. In adults, the foreskin tissue completely covers the penile shaft skin defect. It is a viable reconstructive surgical technique that is easily reproducible and has excellent aesthetic and functional results. For this surgical technique, tissue transfers, bulky regional flaps, or skin grafts were not needed.

Earlobe‐based advancement flap for helical rim defect: A review of 30 cases

Earlobe‐based advancement flap for helical rim defect: A review of 30 cases

The Treatment and Management of Oroantral Communications and Fistulas: A Systematic Review and Network Metanalysis.

The aim of this work was to systematically review and carry out a statistical metanalysis to identify the best treatment for close oroantral communications and fistulas and to avoid the risk of recurrence. An electronic search was conducted on the MEDLINE database (Pubmed), Scopus, and Google scholar using the following keywords: "oro antral communication (OAC)" OR "oro antral fistula (OAF)" OR "antro-oral communication" OR "communication between maxillary sinus and oral cavity" OR "oro-sinusal communication" OR "oro-sinusal fistula" OR "sinus communication" OR "sinus fistula" OR "antral communication" AND "treatment" OR "management" OR "surgical treatment" OR "surgical interventions". This work was performed in accordance with the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses). After article screening, 9 RCTs (randomized controlled trials), comparing two or more techniques, were included in this review. A statistically significant difference was detected in favor of the buccal fat pad compared to the buccal advancement flap and palatal rotational flap. With the limitations of this study, the buccal fat pad showed the best results in terms of communication closure and reducing the risk of relapse.

Finding Perforator "Freeway" for Design Optimization of Expanded Flaps by Indocyanine Green Angiography.

Indocyanine green angiography (ICGA) is a useful tool for the visual assessment of superficial blood flow. Herein, we used ICGA to visualize perforator branches and linking vessels to provide a road map for flap design of an expanded flap. Twenty-eight expansions were planned to use back-cut technique in 26 patients. ICGA was used to visualize perforator branching pattern with the linking vessels and the venous network in the expanded flap before expander explantation. The appropriate perforator was selected, and the flap was designed following the axiality of its branch linked by true anastomoses. The vein running closely was chosen as the axial vein. The back cut was designed to avoid transection of the axial artery and vein. Patient demographics, defect characteristics, and reconstructive outcomes were assessed. ICGA clearly visualized the perforator branches and the linking vessels in the expanded flap at the head and neck, trunk, and extremity. The back-cut flap containing the axial artery and vein was raised successfully in 27 expansions. The arterial perforator and superficial vein separated greatly and resulted in design modification from back-cut to advancement flap in one expansion. All expanded flaps met the reconstructive needs and exhibited complete survival. ICGA allowed the visualization of the preoperative topography of the vascular network in the expanded flap and helped surgeons locate the vascular axis and perform an appropriate back-cut design for efficient and safe flap transfer.